RAND Launches Tool to Evaluate Health Reform Proposals

January 14, 2009

‘COMPARE’ provides global positioning system for health-care policy

The RAND Corporation today launched an online tool to provide policymakers and interested parties with a unique way of understanding and evaluating the effects and unintended consequences of health care reform proposals certain to be introduced in the new 111th Congress and beyond.

COMPARE (Comprehensive Assessment of Reform Efforts) is a first-of-its-kind online resource that synthesizes what is known about the current heath care system, provides information on proposals to modify the system and delivers insight about how potential policy changes are likely to affect health care delivery and costs in the United States.

The centerpiece of COMPARE is a policy options “dashboard” that offers both a snapshot and an in-depth look at the implications that various policy changes could have on a range of outcomes like costs to government and others, quality of care, and access to care, as well as the ease with which changes could be implemented. The dashboard also depicts gaps in our knowledge about the consequences of changes in our health care system.

Results on the dashboard are informed by a review of prior experience with the policy options and a state-of-the-art microsimulation modeling tool that allows policymakers to estimate the impact of specific policy changes on coverage, spending, consumer financial risk and health. COMPARE’s modeling tool is uniquely transparent; users can see how much a change in a particular design element — for example, the different sizes of firms subject to an employer mandate — would affect outcomes.

RAND developed COMPARE to provide an objective, nonpartisan source of analysis that can inform the anticipated upcoming public dialogue about health care reform and to help policymakers develop more effective options going forward.

“COMPARE is a global positioning system for health care policy,” said Elizabeth McGlynn, associate director of RAND Health and co-director of COMPARE. “It is a tool that tells us where we are and, more importantly, where the new proposals will take us in the immensely complex matter of health care reform.

“There is no magic solution to our nation’s health care challenges, and every proposal likely to emerge will contain inevitable trade-offs between cost and quality of care and access to it. COMPARE will help make realistic assessments, based on objective standards and facts, and therefore encourage a full understanding of the immensely complicated benefits and risks of the policy choices ahead.” Among the new findings revealed in the dashboard:

An individual mandate is the most cost-effective strategy for decreasing the number of uninsured.

For most options, how the policy is designed has a significant impact on how effective it will be and whether there will be unintended consequences. For individual mandates, for example, the level of subsidies that would be available, the development of a national insurance exchange, and the penalties for noncompliance all determine likely reductions in the uninsured and the associated costs to the government and others.

There is a link between having health insurance and life expectancy. The model estimates that life expectancy would increase by six months on average among newly insured persons who maintain coverage until age 65.

There is no evidence that many of the proposals for saving money — prevention, disease management, pay-for-performance, malpractice reform — will actually reduce spending on health care in the next decade.

Payment reform options are likely to produce the greatest opportunity for

COMPARE is a one-stop location for detailed information on the present state of the American health care system. Data on spending, reliability, patient experience, coverage and capacity will provide visitors to the site with a broad understanding of current policy and health in the United States today.

“All the parties in the coming health care debate will have their own opinions on how best to address the challenges we face,” said Jeffrey Wasserman, co-director of COMPARE and a senior policy researcher at RAND. “We created COMPARE to contribute credible, objective and easy-to-understand facts and analysis so that those opinions can be based on real information. We don’t expect that everyone will like everything COMPARE reports, but we hope everyone will recognize the contribution COMPARE makes to the health care debate.”

COMPARE is built to last with a modular, flexible design that will enable RAND to continue to contribute to debates about health policy issues into the future. RAND researchers plan to expand the modeling to estimate the effects of different proposals for improving the delivery of health services, reducing the rate of cost growth and reforming payment systems. The COMPARE team will interact with policymakers to provide information that can shape the design of new proposals.